Echocardiography, Three-Dimensional – ABC CARDIOL

ABCIC

Review Article

Use of Three-Dimensional Echocardiography in the Analysis of Ventricular Function in Chagas Disease

Antonio Carlos Leite de Barros Filho et al. Minna Moreira Dias Romano

Abstract

Chagas disease is recognized as a global public health issue, capable of causing cardiac, digestive, and neurological manifestations. The echocardiogram is a fundamental complementary exam in assessing patients with cardiac involvement, evaluating various parameters of cardiac structure and function. This review aims to discuss the use of three-dimensional echocardiography in analyzing ventricular function in patients with Chagas disease.

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Case Report

Incidental Finding of Arrhythmogenic Right Ventricular Cardiomyopathy in a 72-Year-Old Man Admitted With Acute Coronary Syndrome

Rafael Modesto Fernandes et al. Luciana Cunha Weber Vitor Queiroz de Castro Souza Mariana Baptista Guedes … Diogo Freitas Cardoso de Azevedo Marcia Maria Nova Rabelo

Introduction

Arrhythmogenic right ventricular cardiomyopathy (ARVC) – also known as arrhythmogenic right ventricular (RV) dysplasia – is a genetic disorder characterized by progressive loss of RV cardiomyocytes, which are replaced with fibrofatty tissue. This replacement may delay intraventricular conduction and contribute to ventricular arrhythmias through a fibrosis-related macro-reentry mechanism. Thus, ARVC is one of the main causes of arrhythmic cardiac arrest in young people and athletes.

Although initially designated as dysplasia, ARVC is not a congenital defect in the myocardium development. It is caused by mutations in the genes that encode desmosomal proteins, which are responsible for cell-to-cell adhesion. This discovery led to the disease being recognized as cardiomyopathy and included in the classification of cardiomyopathies by the American Heart Association.^,

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Case Report

Dual Mechanism of Mitral Valve Injury: Additional Value of Three-Dimensional Transesophageal Echocardiography

Larissa Neto Espíndola et al. Angele Azevedo Alves Mattoso Geórgia dos Santos Couto Pompílio Sampaio Britto

Abstract

Infective endocarditis (IE) is a life-threatening condition and during its course several complications may occur, including embolic events, perivalvular extension and valvular destruction. Echocardiography is fundamental across all stages of the disease, from the diagnosis until the follow-up after completion of the definitive therapy. Three-dimensional transesophageal echocardiography (TEE) can demonstrate a better anatomical definition and it is especially useful in the assessment of perivalvular extension of the infection, prosthetic valve dehiscence and valve perforation. In this article we report a case of double damage in the same mitral valve: leaflet perforation and rupture of chords in a patient with IE.

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Review Article

My Approach to Three-Dimensional Echocardiography for Pathophysiological Classification of Tricuspid Regurgitation

Alex dos Santos Felix et al. Monica Luiza de Alcantara Konstantinos Papadopoulos

Introduction

Although it was known as the “forgotten valve” in the past, there has been increasing interest in studying the tricuspid valve (TV) during the last two decades. Tricuspid regurgitation (TR) has been identified as a prognostic marker not only when associated with other cardiac diseases, like heart failure, mitral regurgitation, or aortic stenosis,^– but also as an isolated entity. Understanding the pathophysiological mechanisms of this disease is of paramount importance, since new options of transcatheter devices and techniques are emerging, offering invasive treatment for high-risk patients unsuitable for surgical intervention.

The TV is difficult to image in transesophageal echocardiography (TEE) for the following reasons: 1) the leaflets are much thinner compared to mitral leaflets, with greater anatomic variability; 2) it is an anterior structure, far away from the esophagus, with acoustic shadowing from the fibrous heart skeleton; and 3) it cannot be aligned to the esophageal probe in order to acquire en face views and requires use of lateral resolution. These restrictions may limit the ability of traditional TEE to evaluate the TV, making it necessary to complement the evaluation with special windows from the lower esophagus and transgastric views. Different from other cardiac valves, images of the TV obtained from transthoracic echocardiography (TTE) usually have better resolution than images obtained by TEE. Even though all protocols start with two-dimensional (2D) assessment of the TV, three-dimensional echocardiography (3DE) plays an important role in the evaluation of TV diseases, due not only to its ability to precisely depict the anatomy of the valve and the subvalvular apparatus, but also to its accuracy in quantitation of right ventricular (RV) and right atrial volumes and function and functional analysis of valvular dysfunction, especially for grading TR and evaluating dynamics of the tricuspid annulus (TA) through dedicated software. All of this information is of unparalleled importance for patient management and pre-procedural planning in surgical and transcatheter approaches.

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Case Report

Real-time Three-Dimensional Echocardiogram in the Identification of Late Complications in the Follow-Up After Mitraclip® Implantation

Alexandre Costa et al. Bruna de Mattos Ivo Junqueira Carolina Thé Macedo Marcus Vinicius Silva Freire de Carvalho … Cristiano Guedes Bezerra Rodrigo Morel Vieira de Melo

Introduction

Conventional surgery is the treatment of choice for severe mitral valve regurgitation. However, it is not feasible for patients at high surgical risk, who have high morbidity and mortality rates despite clinical treatment. Percutaneous valve treatment (MitraClip) has been evolving as a therapeutic perspective for this population, with reduced heart failure (HF) hospitalization and all-cause mortality rates.^,,

Three-dimensional transesophageal echocardiography (3DTEE) has an additive role during clinical follow-up, especially in cases of suspected late complications with high detail of valve anatomy and clip positioning with cardiac structures. Additionally, due to the greater anatomical accuracy of this test, complications resulting from the procedure can be safely detected in real time.

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Review Article

Stress Echocardiography Using Real-Time 3D Imaging

José Roberto Matos-Souza et al. Guilherme De Rossi

Abstract

The need to examine the heart using a three-dimensional (3D) tool is not new. This complex and dynamic organ has always required 3D and real-time understanding. Without this feature, the examiner has to transform two-dimensional images to understand its volume, which requires complex knowledge and approximation interactions. Echocardiography was invented three decades ago, and its improvements resulted in commercial products at the beginning of the century. Some studies demonstrate 3D equivalence with gains in handling the necessary time. We use triplane modalities in our routine, with time gain and less stress on the examiner’s upper limb. Thus, 3D examinations can answer more complex questions and provide a more geometric approach to contraction, with thickening being analyzed in the background.

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Case Report

Carcinoid Syndrome with Involvement of Tricuspid and Pulmonary Valves: Findings on Three-Dimensional Echocardiography

Eduardo Menti et al. Renata Patrícia Moreira Camargo Marcia Castilhos Puchalski Felipe Gropelli Crochemore Fabio Moreira Cañelas

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Editorial

Embolic Complications in Infective Endocarditis: How Can We Predict Using a Risk Evaluator Score (SORTIE or ABCDE)

Cesar Augusto da Silva Nascimento

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Original Article

Semiautomatic Quantification of Left Ventricular Ejection Fraction and Volumes by Two-Dimensional Echocardiography: Comparison with Automatic Three-Dimensional Echocardiography

Rafael Borsoi et al. Miguel Morita Fernandes da Silva Silvio Henrique Barberato

Abstract

Background

Left ventricular ejection fraction is one of the most used echocardiographic parameters in clinical practice. Its estimation by two-dimensional manual method (Simpson method) has limited reproducibility and accuracy, and semi-automatic methods have been proposed. It becomes necessary to compare the semi-automatic two-dimensional method with more accurate methods of assessing left ventricular ejection fraction, such as measurement by automatic three-dimensional echocardiography.

Objective

To compare the left ventricular ejection fraction, and left ventricular end-diastolic and end-systolic volumes estimates by the semi-automatic two-dimensional method with those obtained using the automatic three-dimensional method.

Method

Observational cross-sectional study, including patients in sinus rhythm, left ventricular ejection fraction > 50% and without significant structural heart disease, submitted to transthoracic echocardiography. Student’s t test, Pearson’s coefficient and Bland-Altman analysis were used in the statistical analysis.

Results

Forty patients were included, 53% women, 35% with arterial hypertension, 25% with dyslipidemia, 10% diabetic, 10% smokers and 13% with previous angioplasty. The mean values of left ventricular ejection fraction by three-dimensional and two-dimensional were 62.1 ± 5.8% and 61.7 ± 5.9% (p = 0.50), respectively. There was a strong correlation between left ventricular ejection fraction determined by two-dimensional and three-dimensional (r = 0.75; p <0.001), as well as with left ventricular end-diastolic (r = 0.75; p <0.001) and end-systolic (r = 0.76; p < 0.001). There was good agreement between two-dimensional and three-dimensional left ventricular ejection fraction (mean difference: -0.39; 95% confidence interval -1.7-0.9).

Conclusion

Left ventricular ejection fraction estimated by the two-dimensional semi-automatic method showed good agreement with the automatic three-dimensional method. The findings suggest the two-dimensional semi-automatic method as a reliable alternative for assessing volumes and left ventricular ejection fraction.

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Editorial

Assessment of Aortic Valve Regurgitation by Echocardiography: Basic and New Concepts

Conclusion

Introducing new concepts or techniques that can help grading AR severity is a valuable resource. AR VTI is a promising concept that is physiologically sound and appears reproducible. Larger clinical trials will be needed to further assess its role and, more importantly, its prognostic value and correlation with clinical outcomes.

It is imperative, however, to keep in mind that it is very unlikely that we will find a single echocardiographic marker that will be a gold standard when assessing AR severity. The echocardiographist has to keep an open mind and integrate all available data to come to a final conclusion. This includes the following:

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Editorial

Real-Time Three-Dimensional Echocardiography and Myocardial Strain: Ready for Use in Clinical Practice

Frederico Jose Neves Mancuso

The ability of echocardiography to quantify volumes and to evaluate the contractile function of cardiac chambers has evolved greatly in recent years, particularly due to the development of real-time three-dimensional echocardiography (echo3D) and the possibility myocardial deformation (Strain) analysis by the speckle tracking technique.^–

Unlike two-dimensional echocardiography, where geometric inferences and mathematical calculations are required, the echo3D allows direct measurement of ventricular and atrial volumes, from which function data such as left and right ventricular ejection fraction, and left atrial function, including total emptying fraction and active emptying fraction parameters.^–

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Original Article

3-Dimensional Echocardiography and 2-D Strain Analysis of Left Ventricular, Left Atrial and Right Ventricular Function in Healthy Brazilian Volunteers

Roberto M. Saraiva et al. Eliza Maria B. Scolin Nicole P. Pacheco Maria Eduarda Bouret … Mauro Felippe Felix Mediano Marcelo T. Holanda Andréa R. da Costa

Abstract

Background:

New echocardiographic techniques are used in the diagnosis and prognosis of many heart diseases. However, reference values in different populations are still needed for several of these new indexes. We studied these new echocardiographic parameters in a group of Brazilians with no known cardiovascular disease.

Objective:

To study values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age.

Methods:

Cross-sectional study that included healthy individuals who underwent three-dimensional echocardiography (3DE) and two-dimensional speckle tracking echocardiography (STE) strain (e) analysis. Left atrial (LA) and left ventricular (LV) function were analyzed by 3DE and STE, and right ventricular (RV) function by STE. P values < 0.05 were considered significant.

Results:

Seventy-seven subjects (46.7% men; 40.4 ± 10.4 years) were included. Maximum, minimum and pre-atrial contraction (pre-A) LA volumes (ml/m²) were 21.2 ± 5.5, 7.8 ± 2.5, and 11.0 ± 3.1, respectively. Peak positive global LA e (LAScd), peak negative global LA e and total global LA e (LASr) were 17.4 ± 5.2%, -13.2 ± 2.0% and 30.5 ± 5.9%, respectively. LV end-diastolic and end-systolic volumes (ml/m²) measured 57 ± 12 and 24 ± 6, and 3D LV ejection fraction measured 58 ± 6%. Global LV longitudinal, circumferential and radial e were -19 ± 2%, -19 ± 3%, and 46 ± 12%, respectively. LV torsion measured 1.6 ± 0.7⁰ /cm. Global longitudinal RV e (RV-GLS) and RV free wall strain were -22 ± 3% and -24 ± 5%. Minimum LA and pre-A volumes, LV apical rotation, torsion and RV-GLS increased with age, while total and passive LA emptying fractions, LAScd, LASr, LV end-diastolic and end-systolic volumes decreased with age.

Conclusion:

Values for new echocardiographic indexes in Brazilians without known cardiovascular disease and their correlation with age are presented.

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Editorial

Three-dimensional Speckle Tracking Echocardiography in Amyloidosis: A New Assessment Method for a Rare Disease

Brivaldo Markman Filho

Immunoglobulin deposition in the myocardium characterizes involvement of cardiac amyloidosis (CA). Fibrillary infiltration, which may happen in every heart cavity, leads to the restrictive cardiomyopathy phenotype, with complex pathophysiological mechanisms, which will result in the syndromic diagnosis of congestive heart failure. Diastolic dysfunction is dominant in most cases, and it may or may not, follow diverse levels of systolic dysfunction in the most advanced phases of the disease. Atrial remodeling by amyloid infiltration may contribute to cardiac output decrease by means of insufficient or nonexistent telediastolic atrial contraction. The onset of atrial electrical instability, ending in atrial fibrillation, highlights symptomatic worsening and these patients’ reserved prognosis.

Historically, the right cavities of the heart have been neglected in echocardiographic assessments. The complex morphology of the right ventricle (RV) has possibly contributed for the lack of reproducible data on echocardiographic cutting plans, diversely from the left ventricle (LV). The development of three-dimensional echocardiography (3DE) has allowed for a more accurate calculation of right ventricle volume and function in the diverse pathologies involving that chamber.

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Challenging Evaluation of Aortic Regurgitation: More Than a Quadricuspid Valve

Gonçalo Pestana et al. Carla Sousa Teresa Pinho Sara Maia M. Júlia Maciel

A 61-year-old female patient with chronic obstructive pulmonary disease, and no other comorbidities, was referred for cardiological assessment due to aggravated exertional dyspnea (New York Heart Association – NYHA class III) and atypical chest pain. Physical examination disclosed only a diastolic murmur in the second intercostal space in the right sternal border.

The transthoracic echocardiogram (TTE) showed aortic regurgitation (), with non-dilated cardiac chambers and preserved biventricular function. The acoustic window limited the evaluation of the valvular lesion severity and its importance in the context of the complaints, although the continuous Doppler spectrum suggested significant regurgitation (). The evaluation was further impaired by a systolic flow acceleration in the Left Ventricular Outflow Tract (LVOT), with no significant gradient and an undetermined cause. The aortic root had normal size, but it was not possible to carry out an adequate morphological and functional characterization of the valve.

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Letter to the Editor

Challenges For Percutaneous Left Atrial Appendage Closure: Imaging And Residual Flow

Tarik Yildirim et al. Ibrahim Altun Mustafa Ozcan Soylu

We have read with great interest the paper entitled ‘First results of the Brazilian Registry of Percutaneous Left Atrial Appendage Closure’ by Guérios et al. is a very important study. We have some suggestions about this trial.

Firstly, two-dimensional transeosophageal echocardiography (2D-TEE) can evaluate the morphology of left atrial appendage in multiple views. But real-time three-dimensional transeosophageal echocardiography (3D-TEE) provides more detailed images of the left atrial appendage (LAA) anatomy than 2D-TEE. A competent physician can accurately evaluate the LAA depth and landing zone. Moreover LAA closure depends on an accurate determination of anatomical structure. Therefore the 3D-TEE may show advantantages in relation to 2D-TEE in transcathater LAA closure.

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Original Article

Three-Dimensional Volumetric Assessment of Diastolic Function by Cardiac Magnetic Resonance Imaging: The Multi-Ethnic Study of Atherosclerosis (MESA)

Marcelo S Nacif et al. Andre L. C. Almeida Alistair A Young Brett R Cowan … Anderson C Armstrong Eunice Yang Christopher T Sibley W. Gregory Hundley Songtao Liu Joao AC Lima David A Bluemke

Abstract

Background:

Cardiac Magnetic Resonance is in need of a simple and robust method for diastolic function assessment that can be done with routine protocol sequences.

Objective:

To develop and validate a three-dimensional (3D) model-based volumetric assessment of diastolic function using cardiac magnetic resonance (CMR) imaging and compare the results obtained with the model with those obtained by echocardiography.

Methods:

The study participants provided written informed consent and were included if having undergone both echocardiography and cine steady-state free precession (SSFP) CMR on the same day. Guide points at the septal and lateral mitral annulus were used to define the early longitudinal relaxation rate (E’), while a time-volume curve from the 3D model was used to assess diastolic filling parameters. We determined the correlation between 3D CMR and echocardiography and the accuracy of CMR in classifying the diastolic function grade.

Results:

The study included 102 subjects. The E/A ratio by CMR was positively associated with the E/A ratio by echocardiography (r = 0.71, p < 0.0001). The early diastolic relaxation velocity by tissue Doppler and longitudinal relaxation rate for the lateral mitral annulus displacement were positively associated (p = 0.007), as were the ratio between Doppler E/e' and CMR E/E' (p = 0.01). CMR-determined normalized peak E (NE) and deceleration time (DT) were able to predict diastolic dysfunction (areas under the curve [AUCs] = 0.70 and 0.72, respectively). In addition, the lateral E/E' ratio showed good utility in identifying diastolic dysfunction (AUC = 0.80). Overall, echocardiography and CMR interobserver and intraobserver agreements were excellent (intraclass correlation coefficient range 0.72 – 0.97).

Conclusion:

3D modeling of standard cine CMR images was able to identify study subjects with reduced diastolic function and showed good reproducibility, suggesting a potential for a routine diastolic function assessment by CMR.

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Three-dimensional Echocardiography for Percutaneous Occlusion of Patent Foramen Ovale

Robinson Poffo et al. Paola Keese Montanhesi Renato Bastos Pope Alisson Parrilha Toschi Marcelo Campos Vieira

Female patient, 31 years old, with a history of ischemic stroke 7 years before, was referred for treatment of Patent Foramen Ovale (PFO). She only had a complaint of migraine with aura, with no focal neurological abnormalities.

On July 2, 2015, she was submitted to an uneventful percutaneous PFO occlusion using a Cardia Intrasept^TM prosthesis (CARDIA, Inc., Burnsville, MN, USA). Intraoperative three-dimensional transesophageal echocardiography confirmed correct prosthesis positioning and absence of residual shunt through the bubble test. Current guidelines of the two most important international societies of echocardiography, the European Association of Cardiovascular Imaging and the American Society of Echocardiography, determine that the three-dimensional echocardiography is the echocardiographic modality of choice for monitoring, following and guiding percutaneous procedures performed in hemodynamics and hybrid rooms, as in this case.

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Multimodality Images of a Mixed Atrial Septal Defect

Zafer Işılak et al. Uğur Küçük Omer Uz Murat Yalçın Veysel Temizkan

A 20-year-old male patient with dyspnea complaint was referred to our hospital. On physical examination there was grade 2/6 systolic murmur, which is best heard at the second left intercostal space and fixed split S₂. ECG revealed sinus rhythm with complete right bundle brunch block. Transthoracic echocardiography demonstrated a secundum atrial septal defect (ASD) and Qp/Qs ratio was 1.6. The right ventricle was severely dilated, inconsistent with the size of the defect. Two-dimensional and color Doppler transesophageal echocardiographic examination confirmed the secundum type ASD (asterisk) and revealed an additional sinus venosus type ASD between the right atrium and the superior vena cava (SVC)(, , ; ). Three-dimensional transesophageal echocardiography verified both septal defects (). The patient underwent cardiac tomography for further anatomical outlining the. and clearly show the secundum ASD (asterisk), sinus venosus ASD (arrow) and anomalous drainage of the right superior pulmonary vein to the SVC (star). The patient underwent surgery. and show intraoperative images of the defects.

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Original Article

Left Atrial Volume Determinants in Patients with Non-Ischemic Dilated Cardiomyopathy

Frederico José Neves Mancuso et al. Valdir Ambrósio Moisés Dirceu Rodrigues Almeida Dalva Poyares … Luciana Julio Storti Wércules Antonio Oliveira Flavio Souza Brito Angelo Amato Vincenzo de Paola Antonio Carlos Camargo Carvalho Orlando Campos

Background:

Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure.

Objective:

We aimed to evaluate the determinants of LAV in patients with dilated cardiomyopathy (DCM).

Methods:

Ninety patients with DCM and left ventricular (LV) ejection fraction ≤ 0.50 were included. LAV was measured with real-time three-dimensional echocardiography (eco3D). The variables evaluated were heart rate, systolic blood pressure, LV end-diastolic volume and end-systolic volume and ejection fraction (eco3D), mitral inflow E wave, tissue Doppler e´ wave, E/e´ ratio, intraventricular dyssynchrony, 3D dyssynchrony index and mitral regurgitation vena contracta. Pearson´s coefficient was used to identify the correlation of the LAV with the assessed variables. A multiple linear regression model was developed that included LAV as the dependent variable and the variables correlated with it as the predictive variables.

Results:

Mean age was 52 ± 11 years-old, LV ejection fraction: 31.5 ± 8.0% (16-50%) and LAV: 39.2±15.7 ml/m². The variables that correlated with the LAV were LV end-diastolic volume (r = 0.38; p < 0.01), LV end-systolic volume (r = 0.43; p < 0.001), LV ejection fraction (r = -0.36; p < 0.01), E wave (r = 0.50; p < 0.01), E/e´ ratio (r = 0.51; p < 0.01) and mitral regurgitation (r = 0.53; p < 0.01). A multivariate analysis identified the E/e´ ratio (p = 0.02) and mitral regurgitation (p = 0.02) as the only independent variables associated with LAV increase.

Conclusion:

The LAV is independently determined by LV filling pressures (E/e´ ratio) and mitral regurgitation in DCM.

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Case Report

Isolated Anterior Mitral Valve Leaflet Cleft: 3D Transthoracic Echocardiography-Guided Surgical Strategy

Marcelo Haertel Miglioranza et al. Denisa Muraru Sorina Mihaila José Carlos de Araujo Haertel … Sabino Iliceto Luigi Paolo Badano

Introduction

Isolated cleft of the anterior mitral leaflet (not associated with atrioventricular septal defect) is a rare cause of congenital mitral regurgitation. When feasible, mitral valve repair (direct suturing of the cleft with or without prosthetic annular ring insertion) is preferable to valve replacement. We report a clinical case in which we describe the usefulness of three-dimensional (3D) transthoracic echocardiography (TTE) for diagnosis and morphological assessment of the defect to assist in planning the surgical procedure.

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Artigo Original

3D Echo pilot study of geometric Left Ventricular changes after acute myocardial infarction

Marcelo Luiz Campos Vieira et al. Wercules Antonio Oliveira Adriana Cordovil Ana Clara Tude Rodrigues … Cláudia Gianini Mônaco Tânia Afonso Edgar Bezerra Lira Filho Marco Perin Cláudio Henrique Fischer Samira Saady Morhy

BACKGROUND: Left ventricular remodeling (LVR) after AMI characterizes a factor of poor prognosis. There is little information in the literature on the LVR analyzed with three-dimensional echocardiography (3D ECHO). OBJECTIVE: To analyze, with 3D ECHO, the geometric and volumetric modifications of the left ventricle (VE) six months after AMI in patients subjected to percutaneous primary treatment. METHODS: Prospective study with 3D ECHO of 21 subjects (16 men, 56 ± 12 years-old), affected by AMI with ST segment elevation. The morphological and functional analysis (LV) with 3D ECHO (volumes, LVEF, 3D sphericity index) was carried out up to seven days and six months after the AMI. The LVR was considered for increase > 15% of the end diastolic volume of the LV (LVEDV) six months after the AMI, compared to the LVEDV up to seven days from the event. RESULTS: Eight (38%) patients have presented LVR. Echocardiographic measurements (n = 21 patients): I- up to seven days after the AMI: 1- LVEDV: 92.3 ± 22.3 mL; 2- LVEF: 0.51 ± 0.01; 3- sphericity index: 0.38 ± 0.05; II- after six months: 1- LVEDV: 107.3 ± 26.8 mL; 2- LVEF: 0.59 ± 0.01; 3- sphericity index: 0.31 ± 0.05. Correlation coefficient (r) between the sphericity index up to seven days after the AMI and the LVEDV at six months (n = 8) after the AMI: r: 0.74, p = 0.0007; (r) between the sphericity index six months after the AMI and the LVEDV at six months after the AMI: r: 0.85, p < 0.0001. CONCLUSION: In this series, LVR has been observed in 38% of the patients six months after the AMI. The three-dimensional sphericity index has been associated to the occurrence of LVR.

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Case Report

"Hyper-response" evaluated by 3D echocardiography after cardiac resynchronization therapy

Viviane Tiemi Hotta et al. Marcelo Luiz Campos Vieira Daniela do Carmo Rassi Silvana Angelina D'orio Nishioka … Martino Martinelli Filho Wilson Mathias Jr

Cardiac resynchronization therapy consists of a promising treatment for patients with severe heart failure, but about 30% of patients do not exhibit clinical improvement with this procedure. However, approximately 10% of patients undergoing this therapy may have hyperresponsiveness, and three-dimensional echocardiography can provide an interesting option for the selection and evaluation of such patients.

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Artigo Original

Comparison between 2D and 3D echocardiography in the evaluation of reverse remodeling after CRT

Viviane Tiemi Hotta et al. Martino Martinelli Filho Charles Mady Wilson Mathias Jr. Marcelo L.C. Vieira

BACKGROUND: Echocardiography is a useful method for screening and assessing response to cardiac resynchronization therapy (CRT). 3D echocardiography has already established its role in the evaluation of ventricular volumes and ejection fraction (LVEF) with excellent correlation of results when compared with MRI. OBJECTIVE: To compare the evaluation of ventricular volumes (LVDV, LVSV), LVEF, and LV mass before and after CRT by 2D echocardiography and three-dimensional echocardiography. METHODS: We evaluated 24 patients with HF FCIIIouIV (NYHA), sinus rhythm QRS > 150 ms, during an optimized therapy for HF undergoing CRT. We conducted electrocardiogram (ECG), clinical evaluation, 2D and 3D echocardiography before, three and six months after CRT. The comparison between the techniques was performed using Pearson’s correlation (r). Results: At baseline, the correlation between methods was 0.96 for evaluation of LVDV, 0.95 for evaluation of LVSV, 0.87 for LVEF and 0.72 for LV mass. After three months of CRT, the correlation between methods for analysis of LVDV was 0.96, 0.95 for LVSV, 0.95 for LVEF, and 0.77 for LV mass. After six months of CRT, the correlation between 2D and 3D echocardiography for analysis of LVDV was 0.98, 0.91 for LVSV, 0.96 for LVEF, and 0.85 for LV mass. CONCLUSION: This study reported was a reduction of LVDV, LVSV, besides improvement in LVEF after CRT. There was an excellent correlation between the 2D and 3D echocardiography for evaluation of ventricular volumes and LVEF, and a good correlation between methods for evaluation of left ventricular mass before and after CRT.

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